PTSD Needs a New Name

A retired general finds fault with the term "disorder."

Post-Traumatic Stress Disorder has been called many things over the years, from shell shock to "irritable heart." Now a Seattle-based retired general and former Army vice-chief of staff is trying to change the name again to encourage more soldiers to seek treatment.

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As he asserted at a Philadelphia meeting of the American Psychiatric Association earlier this month, Gen. Peter Chiarelli wants to replace the word "disorder" with "injury"—ultimately changing PTSD to PTSI. His position, supported by other military officials, has generated considerable debate, with coverage in The Washington Post and Time's Battleland blog.

A Seattle native, Chiarelli moved home after his retirement in January. He now heads a nonprofit working on brain research called One Mind for Research, which last week held its first annual meeting in Los Angeles.

Speaking from L.A., he gives what he says is a common reaction of a young soldier told he should see a therapist. "The kid says, 'I don't want to be diagnosed with a disorder. What I'm suffering from is a direct result of a traumatic experience in combat.' "

"Disorder" implies that something is something is wrong with the person, Chiarelli suggests, whereas "injury" would put PTSD on par with other war wounds. "We call it Traumatic Brain Injury, don't we?" he asks, rhetorically.

Chiarelli says it's not only war situations in which the current name may do damage. Take, for instance, sexual-assault victims, who are frequently diagnosed with PTSD. "Is it right to tell a woman who's been raped that because she has a reaction to that, that she has a 'disorder'?" he wonders aloud.

But PTSD is a particularly significant diagnosis in the military. A lot of benefits ride on it, as is evident from the recent scandal at Madigan Army Medical Center at Joint Base Lewis-McChord, in which the hospital's forensic psychologists urged sparing use of the diagnosis because of the costs involved.

A name change wouldn't impact benefits, Chiarelli claims. But others aren't so sure. "When you have an injury, you follow a treatment regimen and expect to get better," Charles Figley, director of Tulane University's Traumatology Institute, told The Washington Post.

Chiarelli holds that a big part of the problem is that we simply don't know enough about the brain to understand PTSD very well, and there's no reliable test that allows doctors to diagnose it. "It's not like you taking your temperature, or seeing a leaky valve," he says.

Similarly, Chiarelli says that too little is known about TBI. He says his frustration with that lack of knowledge after 10 years of war ultimately led him to One Mind for Research, which aims to become the American Heart Association of brain research, bringing together balkanized fields of study. Housed in the University District, the organization's first order of business is stimulating more research on TBI and what Chiarelli hopes will be called PTSI.